HomeMy WebLinkAboutMiscellaneous - 148 MAIN STREET 4/30/2018 (2) .� `�
J�
1
Date...."-::.....'.......V.........
f ,kORT11 1
r°•`�`" "°O� TOWN OF NORTH ANDOVER
o
PERMIT FOR WIRING
ACMUS
This certifies that
has permission to perform ............................a .............................................
wiring in the buildingof.........., <_ %..........................................................
at.:/ .......................... '..-. ...��4/............ .North Andover,Mass.
Fee..................... Lic.No, .... 1 L..... : A.e�........................
ELECTRICALJN§PECTOR
Check # -� U
56L" 0
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
BOARD OF FIRE PREVENTIO REGULATIONS Occupancy and Fee Checked
[Rev. 11/991 leave blank
APPLICATION FOR P MIT TO PERFORM ELECTRICAL WORK
All work to be performed in cordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK ORE ALL IN O TION) Date: —/,2—0
City or Town of: f d✓ To the Inspector of Wires:
By this application the undersigned es notice of his or her intention to perform the electrical work described below.
Location(Street&Number) Al ( t?2/4-Ity S T' &-101 (p!72
Owner or Tenant Vtb(,'L j 9tQ'l(0 Telephone No. j y� -O k'6;1—
Owner's
'6;1—Owner's Address
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Q Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Y Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the ollowin table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets l No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o Emergency ig ing
rnd. rnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones
` No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons g
No.of Waste Disposers / Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:
No.of Water No.of No.of No.of Devices or Equivalent
Heaters KW Data Wiring:
Signs Ballasts f Devices or Equivalent
ITeleco unications Wiring:No.Hydromassage Bathtubs No.of Motors Total HPNoof Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) On File Feb/Zoo(p
Estimated Value of Electrical Work:�7.00 __11 (When required by municipal policy.) (Expiration Date)
Work to Start: 2--/0 Of Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: Kelly M.Casey Signature LIC.NO.: 37200
(If applicable,enter "exempt"in the license number line) Bus.Tel.No.: 978-697-4453
Address: 700 Robbins Ave Unit 3 Dracut,Mass 01826 Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ oZ r 00